How NYU Langone Transitioned from Glass to Digital Pathology

Plugging the plug on traditional diagnosis

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Author: Sidney Ocanagil-Tunstall

For NYU Langone’s pathologists, beginning to diagnose digitally did not immediately mean the end of glass slide distribution. Cases continued to be scanned and delivered on glass while specialties settled into the new workflow. Then Dr Syed T. Hoda began to notice a change.

“There’s a box where people pick up their cases, their glass cases, and nobody was checking those boxes after some time,” recalls NYU Langone’s Director of Digital Pathology.

The boxes offered a visible clue, but Hoda was also hearing directly from the pathologists who were embracing the new digital sign out. Some were telling him they no longer needed their glass cases. When could the department stop doing the work of delivering them?

Making the plan known without forcing the decision

Hoda had always intended for all specialties to move beyond a hybrid glass-digital workflow. He made that direction clear to pathologists but in an ideal world did not want the change to feel imposed before they were comfortable diagnosing on screen.

“My theory was not to apply pressure in, in that direct sort of way,” he says. “I made them aware that that was the plan.”

That left room for pathologists to work with digital images and judge whether they still relied on the slides arriving in their collection boxes. The decision to stop distribution would follow their experience of the new workflow, rather than automatically follow the date of their digital go-live.

What Hoda heard surprised him: “half the groups would voluntarily tell me they don’t want the glass anymore.” Pathologists reported that they were no longer using the glass. Digital sign out was becoming popular far faster than the planning team had initially envisioned.

However, Hoda’s account does not suggest that every pathologist left glass behind all at once. It describes groups moving through the transition and, in some cases, raising the question of glass distribution themselves.

When the old workflow became duplicate work

Since there wasn’t a clear jump from traditional to digital sing out, NYU Langone was scanning slides for digital diagnosis while continuing to distribute glass. Keeping both processes running required work from the laboratory even where the delivered slides were no longer being collected.

Hoda puts it plainly: “having this dual workflow of distributing glass and scanning everything is really inefficient.” As he says a moment later, “it’s doing double the amount of work.”

When considering the leap to a digital workflow every implementation team fear becoming stuck in a hybrid trap where pathologists use both traditional and digital sign out. This can happen if lab managers empower their pathologists to make their own choice long term. Hybrid traps equate to double the amount of administrative work and incur major expense.

That is why stopping distribution was a distinct milestone for NYU Langone team. The first go-live showed that a specialty could begin working digitally. The subsequent weeks showed Hoda how pathologists were actually using the two workflows. When groups said they no longer wanted glass, and their collection boxes were going unchecked, continuing to deliver it made less sense.

Although long term the management team were insistent all pathologists must move to digital sign out, Hoda did not set out a formal threshold for withdrawing glass distribution. Instead the team made a decision informed by daily practice: pathologists had become comfortable with the digital sing out, some asked to stop receiving glass, and the laboratory could see the cost of continuing to provide both routes.

For those groups, going glassless was more than adding a digital way to diagnose. It was the point at which NYU Langone could begin taking an unnecessary part of the old workflow away.

Summary

The transition from glass slides to digital pathology at NYU Langone illustrates a gradual but decisive shift in diagnostic workflows, driven by clinician adoption rather than imposed mandates. Initially, the department maintained a hybrid approach, continuing glass slide distribution alongside digital scanning, allowing pathologists to adapt at their own pace. Over time, Director of Digital Pathology Dr. Syed T. Hoda observed that many pathologists stopped retrieving glass slides, signaling a preference for digital diagnosis. This shift was further reinforced by direct feedback from pathologists who reported no longer relying on physical slides. The department’s strategy emphasized flexibility, avoiding rigid deadlines while clearly communicating the long-term goal of full digital adoption. A key insight was the inefficiency of maintaining dual workflows, as scanning and distributing glass slides doubled laboratory workload without adding clinical value. As pathologists grew more comfortable with digital sign-out, some proactively requested discontinuation of glass slide delivery, accelerating the transition. This organic shift allowed NYU Langone to phase out redundant processes based on real-world usage rather than arbitrary timelines. The transition was not uniform, with different specialties progressing at varying rates, but the reduction in glass slide usage demonstrated that digital pathology could fully replace traditional methods when clinicians were adequately supported. The practical takeaway is that successful digital pathology implementation requires balancing clinician autonomy with clear strategic direction. Allowing pathologists to transition at their own pace fosters confidence in digital workflows while minimizing resistance. However, maintaining hybrid workflows indefinitely is unsustainable due to inefficiencies and costs. Institutions should monitor adoption patterns and phase out glass distribution as digital workflows become the norm, ensuring a seamless transition without disrupting diagnostic accuracy or clinician workflow. NYU Langone’s experience highlights the importance of aligning operational changes with actual clinician behavior to achieve sustainable digital transformation.